Cat-scratch disease

For the Ted Nugent album, see Cat Scratch Fever. For peliosis is caused by B. henselae that most often aects
the Nickelodeon cartoon, see Catscratch. patients with HIV and other conditions causing severe
immune compromise. The liver and spleen are primar-
Cat-scratch disease (CSD) is a common and usu- ily aected,[7]with ndings of blood-lled cystic spaces on
pathology. In 2015 a Toledo, Ohio woman lost eyesight
ally benign infectious disease caused by the bacterium [8]
Bartonella henselae.[2][3]
It is most commonly found in in an eye after a cat licked it.
children following a scratch or bite from a cat[2] within
about one to two weeks.

1 Signs and symptoms
Cat-scratch disease commonly presents as tender, swollen
lymph nodes near the site of the inoculating bite
or scratch or on the neck, and is usually limited
to one side. This condition is referred to as re-
gional lymphadenopathy and occurs 13 weeks after
inoculation.[4] Lymphadenopathy in CSD most com-
monly occurs in the arms, neck, or jaw, but may also
occur near the groin or around the ear.[2] A vesicle or
an erythematous papule may form at the site of initial
infection.[2] Most patients also develop systemic symp-
toms such as malaise, decreased appetite, and aches.[2]
Other associated complaints include headache, chills,
muscular pains, joint pains, arthritis, backache, and ab-
dominal pain. It may take 7 to 14 days, or as long as two
months, for symptoms to appear. Most cases are benign
and self-limiting, but lymphadenopathy may persist for
several months after other symptoms disappear.[2] The
disease usually resolves spontaneously, with or without
treatment, in one month.
In rare situations, CSD can lead to the develop-
ment of serious neurologic or cardiac sequelae such
as meningoencephalitis, encephalopathy, seizures, or
endocarditis.[2] Endocarditis associated with Bartonella
infection has a particularly high mortality.[4] Parinauds
oculoglandular syndrome is the most common ocu-
lar manifestation of CSD,[2] and is a granulomatous
conjunctivitis with concurrent swelling of the lymph node
near the ear.[5] Optic neuritis or neuroretinitis is one of
the atypical presentations.[6]
Immunocompromised patients are susceptible to other
conditions associated with B. henselae and B. quintana,
such as bacillary angiomatosis or bacillary peliosis.[2]
Bacillary angiomatosis is primarily a vascular skin lesion
that may extend to bone or be present in other areas of
the body. In the typical scenario, the patient has HIV or
another cause of severe immune dysfunction. Bacillary
2 Cause
Bartonella henselae is a fastidious,[4] intracellular, Gram-
negative bacteria.
2.1 Transmission
The cat was recognized as the natural reservoir of the dis-
ease in 1950 by Robert Debr.[4] Kittens are more likely
to carry the bacteria in their blood, and therefore may be
more likely to transmit the disease than adult cats. How-
ever, eas serve as a vector for transmission of B. henselae
among cats,[4] and viable B. henselae are excreted in the
feces of Ctenocephalides felis, the cat ea.[9] Cats could
be infected with B. henselae through intradermal inoc-
ulation using ea feces containing B. henselae.[10] As a
consequence, a likely means of transmission of B. hense-
lae from cats to humans may be inoculation with ea feces
containing B. henselae through a contaminated cat scratch
wound or by cat saliva transmitted in a bite.[4] Ticks can
also act as vectors and occasionally transmit the bacteria
to humans.[2] Combined clinical and PCR-based research
has shown that other organisms can transmit Bartonella,
including spiders.[11][12] Cryptic Bartonella infection may
be a much larger problem than previously thought, con-
stituting an unrecognized occupational health hazard of
veterinarians.[13]
3 Diagnosis
The WarthinStarry stain can be helpful to show the pres-
ence of B. henselae, but is often dicult to interpret. B.
henselae is dicult to culture and can take 26 weeks to
incubate.[4] The best diagnostic method currently avail-
able is polymerase chain reaction, which has a sensitivity
of 43-76% and a specicity (in one study) of 100%.[4]

1
2 8
High-magnication micrograph of CSD showing a granuloma
(pale cells - right of center on image) and a microabscess with
neutrophils (left of image), H&E stain
3.1 Histology
Cat-scratch disease is characterized by granulomatous
inammation on histological examination of the lymph
nodes. Under the microscope, the skin lesion demon-
strates a circumscribed focus of necrosis, surround by
histiocytes, often accompanied by multinucleated giant
cells, lymphocytes, and eosinophils. The regional lymph
nodes demonstrate follicular hyperplasia with central stel-
late necrosis with neutrophils, surrounded by palisading
histiocytes (suppurative granulomas) and sinuses packed
with monocytoid B cells, usually without perifollicular
and intrafollicular epithelioid cells. This pattern, al-
though typical, is only present in a minority of cases.[14]
4 Treatment
Most healthy people clear the infection without treat-
ment, but in 5 to 14 percent of individuals, the organisms
disseminate and infect the liver, spleen, eye, or central
nervous system.[15] Although some experts recommend
not treating typical CSD in immunocompetent patients
with mild to moderate illness, treatment of all patients
with antimicrobial agents (Grade 2B) is suggested due to
the probability of disseminated disease. The preferred
antibiotic for treatment is azithromycin since this agent is
the only one studied in a randomized controlled study.[16]
Azithromycin is preferentially used in pregnancy to avoid
the teratogenic side eects of doxycycline.[17] However,
doxycycline is preferred to treat B. henselae infections
with optic neuritis due to its ability to adequately pene-
trate the tissues of the eye and central nervous system.[4]
5 Prevention
Cat-scratch disease can be primarily prevented by taking
ea control measures and washing hands after handling
a cat or cat feces; since cats are mostly exposed to eas
REFERENCES
when they are outside, keeping cats inside can prevent
infestation.[18]
6 Epidemiology
Bartonella henselae is found worldwide and CSD has
been observed in many countries. The incidence of CSD
appears to have a seasonal relationship, possibly due to
the mating behavior of the cat ea during certain times
of the year.[4]
7 History
Symptoms similar to CSD were rst described by Henri
Parinaud in 1889, and the clinical syndrome was rst
described in 1950 by Robert Debr.[3][4] In 1983, the
Warthin-Starry silver stain was used to discover a Gram-
negative bacillus which was named Apia felis in 1991
after it was successfully cultured and isolated. The
causative organism of CSD was originally believed to
be Apia felis, but this was disproved by immunological
studies in the 1990s demonstrating that cat-scratch fever
patients developed antibodies to two other organisms, B.
henselae (originally known as Rochalimea henselae be-
fore the genera Bartonella and Rochalimea were com-
bined) and B. clarridgeiae, which is a rod-shaped Gram-
negative bacterium.[4]
8 References
[1] Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L.
(2007). Dermatology: 2-Volume Set. St. Louis: Mosby.
ISBN 1-4160-2999-0.
[2] Klotz SA, Ianas V, Elliott SP (2011). Cat-scratch Dis-
ease. American Family Physician. 83 (2): 1525. PMID
21243990.
[3] Asano S (2012). Granulomatous lymphadenitis. Jour-
nal of Clinical and Experimental Hematopathology. 52
(1): 116. doi:10.3960/jslrt.52.1. PMID 22706525.
[4] Florin TA, Zaoutis TE, Zaoutis LB (2008). Beyond
cat scratch disease: widening spectrum of Bartonella
henselae infection. Pediatrics. 121 (5): e141325.
doi:10.1542/peds.2007-1897. PMID 18443019.
[5] Catscratch Disease~clinical at eMedicine
[6] Gajula V, Kamepalli R, Kalavakunta JK (2014). A star in
the eye: cat scratch neuroretinitis. Clinical Case Reports.
2 (1): 17. doi:10.1002/ccr3.43. PMC 4184768 . PMID
25356231.
[7] Perkocha LA, Geaghan SM, Yen TS, Nishimura SL,
Chan SP, Garcia-Kennedy R, Honda G, Stolo AC,
 3

Klein HZ, Goldman RL (1990). Clinical and patho-
logical features of bacillary peliosis hepatis in associa-
tion with human immunodeciency virus infection. The
New England Journal of Medicine. 323 (23): 15816.
doi:10.1056/NEJM199012063232302. PMID 2233946.
[18] Nelson, Christina A.; Saha, Shubhayu; Mead, Paul S.
Cat-Scratch Disease in the United States, 20052013.
Emerging Infectious Diseases. 22 (10): 17411746.
doi:10.3201/eid2210.160115. PMC 5038427 . PMID
27648778.

[8] Tuey, Holly; Kinsey, Andrew (May 28, 2015). Woman

loses eyesight after her cat licks her. WTOL.
9 External links
[9] Higgins JA, Radulovic S, Jaworski DC, Azad AF
(1996). Acquisition of the cat scratch disease agent Bar- http://www.cdc.gov/bartonella/cat-scratch/index.
tonella henselae by cat eas (Siphonaptera:Pulicidae)". html
Journal of Medical Entomology. 33 (3): 4905.
doi:10.1093/jmedent/33.3.490. PMID 8667399. DermNet bacterial/catscratch
[10] Foil L, Andress E, Freeland RL, Roy AF, Rutledge R,
Triche PC, O'Reilly KL (1998). Experimental infec- Cat Scratch Disease on National Organization for
tion of domestic cats with Bartonella henselae by inocu- Rare Disorders site
lation of Ctenocephalides felis (Siphonaptera: Pulicidae)
feces. Journal of Medical Entomology. 35 (5): 6258. Cat Scratch Fever Disease
doi:10.1093/jmedent/35.5.625. PMID 9775583.
Cat Scratch Fever
[11] Copeland, Claudia S. (2015). Cat Scratch Fever? Re-
ally?: Cats, Fleas and the Many Faces of Bartonellosis.
Healthcare Journal of Baton Rouge: 2834.

[12] Mascarelli PE, Maggi RG, Hopkins S, Mozayeni BR,

Trull CL, Bradley JM, Hegarty BC, Breitschwerdt EB
(2013). Bartonella henselae infection in a family experi-
encing neurological and neurocognitive abnormalities af-
ter woodlouse hunter spider bites. Parasites & Vectors.
6: 98. doi:10.1186/1756-3305-6-98. PMC 3639822 .
PMID 23587343.

[13] Lantos PM, Maggi RG, Ferguson B, Varkey J, Park LP,

Breitschwerdt EB, Woods CW (2014). Detection of Bar-
tonella species in the blood of veterinarians and veterinary
technicians: a newly recognized occupational hazard?".
Vector Borne and Zoonotic Diseases. 14 (8): 56370.
doi:10.1089/vbz.2013.1512. PMC 4117269 . PMID
25072986.

[14] Rosado FG, Stratton CW, Mosse CA (2011). Clinico-

pathologic correlation of epidemiologic and histopatho-
logic features of pediatric bacterial lymphadenitis.
Archives of Pathology & Laboratory Medicine. 135
(11): 14903. doi:10.5858/arpa.2010-0581-OA. PMID
22032579.

[15] Carithers, H. A. (1985-11-01). Cat-scratch disease. An

overview based on a study of 1,200 patients. American
Journal of Diseases of Children (1960). 139 (11): 1124
1133. doi:10.1001/archpedi.1985.02140130062031.
ISSN 0002-922X. PMID 4061408.

[16] Rolain, J. M.; Brouqui, P.; Koehler, J. E.; Maguina,

C.; Dolan, M. J.; Raoult, D. (2004-06-01).
Recommendations for Treatment of Human Infec-
tions Caused by Bartonella Species. Antimicrobial
Agents and Chemotherapy. 48 (6): 19211933.
doi:10.1128/AAC.48.6.1921-1933.2004. ISSN 0066-
4804. PMC 415619 . PMID 15155180.

[17] Catscratch Disease~treatment at eMedicine

4 10 TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

10 Text and image sources, contributors, and licenses

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